Trends and Factors Associated with Compliance to Referrals among Patients Referred from Kyabirwa Surgical Center, Jinja City, Eastern Uganda

Abstract

Background: While surgical patient referrals can avert up to 18% of all deaths, they can burden surgical care-providing facilities if they exceed 10%, compromising the quality of surgical care and potentially damaging the reputation of the referring facility. For Uganda’s first standalone ambulatory surgical care facility, this could spell low acceptability of the novel surgical care model, which promises to increase access to affordable and safe surgery. Objective: To assess referral trends and factors associated with compliance with surgical referrals among patients referred from the Kyabirwa Surgical Center (KSC) between 2019 and 2022. Methods: A cross-sectional design was used; consecutive sampling was used to sample all patients who sought care between 2019 and 2022, and a section of those who were referred. Structured interviews and medical record abstraction were used to collect data that were analyzed in SPSS 25 using frequency distributions and a binomial logit model. Results: Approximately 15.6% of the patients were referred, and 74% of them complied with the referral. Primary-level education and transportation by motorbike to the KSC reduced the odds of compliance. Understanding the reasons for referral, good functional status at the time of referral, perceived short distance to referral facility, being followed up by referral facility, having no fear of referral facility, and education by KSC staff about the referral facility increased the odds of compliance. Conclusion: The prevalence of patient referral was high at KSC between 2019 and 2022, but gradually reduced starting in 2020. Almost all patient referrals performed during the time were clinically justified, because general surgery was the only surgical service present at the time. Of concern, not all patients referred from the KSC complied with the referral; only seven out of every ten of them did, with almost all factors influencing their compliance being intrapersonal.